Final Guidelines Research Articles

22 Digital citizenship among children and youth with autism: Developing guidelines for promoting healthy screen time use

Abstract Background In response to the rising prevalence of screen-based usage among children, particularly those with autism, this study addresses the urgent need for tailored guidelines and strategies to support the digital citizenship and healthy screen time management of children and youth with autism. The currently available screen time guidelines do not adequately account for the specific requirements of autistic children, prompting an exploratory investigation into the information needs of clinicians and families in this domain. Objectives To develop clear and specific guidelines for caregivers and clinicians to facilitate the digital citizenship of children with autism. Design/Methods This multi-phase study was guided by the Knowledge to Action framework for knowledge development (figure 1). First, we identified the existing knowledge gaps regarding screen time use by conducting semi-structured interviews with 15 clinicians. Next, a Delphi method was employed, involving 30 experts in autism, comprising 20 clinicians and 10 caregivers. These experts participated in a series of three surveys, wherein they rated their agreement with a set of statements, encompassing potential guidelines and strategies. Statements that garnered agreement from over 75% of the panel were included in the final guidelines, which were categorized into six sections. In the last phase, evaluation and implementation of the guidelines were studied by asking parents and clinicians for their opinion on key criteria, including accessibility, relevance, clarity, usability, knowledge, and delivery. Results The 1st phase highlighted the need to create uniform recommendations for screen time management. The 2nd phase finalized a set of guidelines comprises six key sections, each playing a pivotal role in promoting healthy screen time use among children with autism: General principles; considerations related to the timing and content of leisure screen time; strategies for caregivers and clinicians to oversee and regulate screen time usage; behavioral indicators of screen time overuse; additional guidelines tailored for clinicians; and a section on resources. In the evaluation phase, participants responded positively and reported that disseminating the guidelines online is feasible and useful. Participant were satisfied with the key criteria with responses scoring between “Somewhat agree” and “Agree” across all domains. Please visit https://asdtechnology.osot.ubc.ca/screen-time-use-guidelines/ Conclusion The guidelines established through this collaborative effort between stakeholders in the autism community provide valuable insights and a tangible framework to address screen time overuse in children with autism. By identifying and addressing the unique needs of this population, these guidelines aim to assist clinicians and caregivers in nurturing healthy digital citizenship among autistic children.

Guidelines to manage women with infertility: an e-Delphi study

Introduction: The psychosocial health problems associated with infertility is compounded in African women when prevailing cultural expectations emphasize the value of parenthood. Despite the social stigma these women endure, they are still mostly managed from a biomedical approach, especially in Ghana, the context of the study. Objective: This study explored the views of a panel of experts to reach consensus on holistic guidelines to manage women with infertility in Ghana. Methods: An e-Delphi technique was employed to retrieve information using a panel of 20 experts. Data collection was conducted in two rounds, and each participating expert was emailed the preliminary guidelines to rate based on certain criteria. Data analysis was done in accordance with the expert participants’ rating of and comments on the guidelines. Results: The final guidelines for holistic healthcare to manage women with infertility include the following interventions: Holistic healthcare assessment, psychological interventions, health education, spiritual support, relevant support from significant others; all within a therapeutic relationship. Conclusion: When healthcare providers use the final set of guidelines to manage women diagnosed with infertility, these women will receive holistic healthcare to attain optimal health and improved chances of conceiving. Keywords: Holistic approach; e-Delphi technique; psychosocial interventions; infertility.

The Egyptian 24-h movement guidelines for children and adolescents: an integration of physical activity, sedentary behaviour, sleep and eating habits—by the Egyptian Academy of Bone and Muscle health

BackgroundThe objectives of this work were as follows: (1) to develop holistic recommendations for physical activity, sleep, sedentary behaviours and eating habits adapted to children and adolescent life stage (5–17 years) and targeting optimal metabolic cycle and achieving energy balance; (2) to provide evidence-based information that can be used by the government, policy makers, healthcare professionals, community, schools as well as families to endorse active, healthy, living in apparently healthy children and youth aged 5–17 years, and as a base for monitoring the activities, particularly the physical ones, on the people level. The Egyptian Academy of Bone and Muscle Health followed an established guideline development process to create the Egyptian 24-h movement clinical guideline for children and adolescents. Online databases (PubMed, Embase and Cochrane Library) were searched for relevant peer-reviewed studies that met the a priori inclusion criteria.ResultsA total of 41 studies met the inclusion criteria. Leveraging evidence from the review of the literature led to the development of 11 key questions covering 8 domains. Fifteen statements focus on the overall identified targets through integration of the movement activities and eating behaviour. Results revealed a major change in the previous basic understandings as it shifts away from segregated into integrated movement behaviour and dietary habit paradigm. Based on this, the final guideline was developed providing evidence-based recommendations for a “Healthy 24-h day”, for Egyptian children and adolescents.ConclusionThe 24-h composition of movement behaviours has principal implications for health at all ages. The developed guideline provides an up-to-date evidence-based recommendation towards a holistic approach for favourable daily life activities and adopts a feasible perspective by outlining these activities within a 24-h period. In addition, eating and dietary elements have been included to complete the energy cycle. Children and adolescents who meet the 24-h movement guidelines generally report more favourable health indicators than those who do not.

Guideline on managing thumb ulnar collateral ligament injuries: the British Society of Surgery for the Hand Evidence for Surgical Treatment (BEST) findings and recommendations.

The development of the ulnar collateral ligament (UCL) guideline was undertaken in accordance with the British Society for Surgery of the Hand Evidence for Surgical Treatment (BEST) Process Manual, which has been accredited by the National Institute for Health and Care Excellence, UK. This review article serves as a summary of the systematic reviews and the final guideline. The group included two patients, a radiologist, a commissioner, an emergency medicine doctor, hand therapists and hand surgeons. The group's recommendations are that patients with acute UCL injuries should be assessed with a history, clinical examination and radiographs. Patients without significant joint laxity can be treated non-surgically. Patients with significant joint laxity on clinical examination may be treated with non-surgical joint immobilization or surgical repair and should reach a shared decision with their clinician about the definitive treatment within 2 weeks of presentation.

Adaptation of mental health first aid guidelines for eating disorders for Iran

BackgroundThis study aimed to adapt mental health first aid guidelines to support individuals with or at risk of developing eating disorders in Iran. This adaptation seeks to enhance the support available for the Iranian population dealing with these disorders.MethodsWe employed the Delphi expert consensus method, utilizing two panels: health professionals (n = 37 in the first round; n = 29 in the second) and individuals with lived experience (n = 20 in the first round; n = 18 in the second). The health professionals panel was selected from the graduates of various eating disorders associated scientific fields who had a history of providing services to or conducting research on people with eating disorders, and the lived experience panel had a history of eating disorders themselves or in their family. The panel of individuals with lived experience included those who had personal or familial histories of eating disorders. Efforts were made to ensure cultural, gender, and age diversity in the selection of panel members. Panellists rated the importance of each item for inclusion in the guidelines for Iran based on the English-language Mental Health First Aid guidelines for eating disorders. Items deemed essential by at least 80% of both panels were included in the final guideline. Additionally, panel members were invited to suggest any missing items.ResultsA total of 57 participants took part in the first round of the survey, and 47 participated in the second round. In the first round, 204 items across 11 categories were assessed, with 174 items endorsed by the panels. Thirteen items were re-scored in the second round, and 17 items were rejected. Participants suggested 11 new items in the first round. In the second round, 18 out of 24 items were endorsed, while six were rejected. Ultimately, 192 items were incorporated into the Iranian guidelines.ConclusionsThe adaptation process considered Iran's social and cultural characteristics, including the stigma associated with mental health disorders, religious beliefs and rituals such as fasting, linguistic differences between English and Farsi, distrust of strangers, the influence of friends and family, differences in food access, and low mental health literacy. We recommend piloting the adapted guidelines in high schools, universities, and non-governmental organizations to evaluate their feasibility and effectiveness in real-world settings. Furthermore, it is essential to establish mechanisms for feedback, update content based on the latest evidence, and collaborate with the media to promote educational programs and public participation.

Promoting research integrity in funding: Co-creating guidelines for research funding organizations.

Research Funding Organizations (RFOs) play an important role in promoting research integrity (RI). Not only do they allocate resources to research institutions and researchers, but they also set and monitor research standards in their funded projects. In spite of their crucial role, there is a paucity of guidance on how RFOs can promote research integrity. As part of the EU-Funded SOPs4RI project, we aimed to address this gap by co-creating guidelines to help RFOs promote RI, engaging a diverse group of stakeholders. Based on a Delphi survey, reviews of evidence and stakeholder interviews, three guideline topics were identified: 1) the selection and evaluation of proposals; 2) monitoring of funded projects; and 3) prevention of unjustified interference. Four sets of co-creation workshops were conducted for each guideline topic, and the input revised and finalized. Understanding these debates could help RFOs from diverse cultural and organizational backgrounds who are developing their own RI guidelines. Therefore, in this paper, we summarize the key results and emphasize the final recommendations. Further, we provide the main points of discussion that occurred during the workshops and explain how they were addressed or resolved in the final guidelines and how they can help in future endeavors to improve funders' practices to foster RI.

Guidelines to support the design, and selection and appraisal of multimedia teaching aids for microbiology education.

Microbiology education has a serious handicap - the lack of visibility of the players of the subject and their interactions - which engenders a disproportionate reliance upon multimedia teaching aids (MTAs). The International Microbiology Literacy Initiative (IMiLI) is creating educational resources in societally-relevant microbiology complemented by appropriate MTAs. However, proper guidance supporting microbiology educators in locating and selecting, or commissioning the creation of, adequate MTAs for different target audiences and learning objectives is lacking. The aims of this study were to (i) identify important considerations regarding educational/didactical standards and the design of educational multimedia and (ii) create an evidence-based guideline for selecting and appraising existing, and informing the creation of new, microbiology MTAs. This investigation is based on an exploratory, mixed-methods approach. The results of two literature reviews (covering educational and good practice multimedia design) informed the collation of a preliminary appraisal guideline for videos, animations, comics, and video games. A web-scraping approach was utilised to locate and retrieve existing exemplars of the four multimedia types and create four pertinent multimedia databases (including metadata). The preliminary guideline was piloted (and revised accordingly) by appraising quasi-random (or purposive) samples of each multimedia type. Educational multimedia experts were interviewed to discuss the findings. Finally, the guideline was updated to reflect the expert comments together with the results of the pilot appraisals. The final guideline has four components: (i) central considerations for selecting and appraising multimedia for specific audiences and educational purposes, (ii) multimedia selection tool, (iii) multimedia appraisal tools, and (iv) extensive background information as appendices linking all sections for further comprehension. Broad utilisation of the guideline has significant potential for simplifying and systematising multimedia selection/creation, leading to superior multimedia-based learning outcomes, establishing a rapid selection database (pre-appraised multimedia), reducing disparities in microbiology education and incentivising educational content creators.

Knowledge, Attitudes, and Practices of Dental Practitioners in Providing Care to Children in Out-of-Home Care: A Scoping Review.

A scoping review was conducted to synthesize available evidence of knowledge, attitudes, and practices of dental practitioners in providing care to children in out-of-home care (OOHC). Scientific databases and the grey literature were searched: 855 studies were screened after removing duplicates; 800 studies were excluded based on the title and/or abstract, and the full text of 55 studies was reviewed, with 7 included in the analysis. These included three peer-reviewed articles regarding the knowledge, attitudes, and practices of dental practitioners in providing care to children in OOHC, as well as four guidelines. Dental practitioners had some knowledge of the high health care needs of OOHC children, but knowledge regarding when children entering care received dental assessment and about OOHC dental care pathways was low. Practices of dental practitioners were varied, most gave oral hygiene instructions, but there was inconsistency in practices regarding continuity of care following placement changes and failure to attend policies. There was more consensus with dental practitioner attitudes, with practitioners in private settings seeming to prefer not to treat children in OOHC. Three of the identified guidelines provided logistical information about OOHC and consent. The final guideline gave practical information on treating children with a background of adverse childhood events (ACEs), including children in OOHC. Further research and education is warranted to aid dental practitioners in providing care to children in OOHC.

The development of the Egyptian 24-h movement guidelines for adults aged 50 years and older: an integration of sleep, sedentary behavior, and physical activity by the Egyptian Academy of Bone and Muscle Health

BackgroundWith the vision of healthy aging, the Egyptian Academy of Bone and Muscle Health followed an established guideline development process to create the Egyptian 24-h movement clinical guideline for adults aged 50 years and older adults. This guideline highlights the significance of movement behaviors across the whole 24-h day. Online databases (PubMed, Embase, and Cochrane Library) were searched for relevant peer-reviewed studies that met the a priori inclusion criteria.ResultsA total of 53 studies met the inclusion criteria. Leveraging evidence from the review of the literature led to the development of 27 statements answering the 5 key questions. Results revealed a major change in the previous basic understandings as it shifts away from focussing on a sole movement behavior to the combination of all the movement behaviors. Based on this, the final guideline was developed providing evidence-based recommendations for a “Healthy 24-Hour Day”, comprising a mix of light-intensity and moderate-to-vigorous-intensity physical activity, sleep, and sedentary behavior.ConclusionThe developed guidelines are meant to help in the decision-making process and are intended for use by adults and older both nationally and internationally; also, for endorsement by the policy-makers. Dissemination and implementation efforts would impact positively on both health professionals and researchers and would also be useful to interested members of the public sector.

ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats.

Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence-based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first line treatment, but optimal treatment regimens beyond glucocorticoids remain uncertain. Additional options include secondary immunosuppressive drugs such as azathioprine, modified cyclosporine, and mycophenolate mofetil, usually selected based on clinician preference. Vincristine, human IV immunoglobulin (hIVIg), and transfusion of platelet or red blood cell-containing products are often used in more severe cases. Splenectomy and thrombopoietin receptor agonists are usually reserved for refractory cases, but when and in which patient these modalities should be employed is under debate. To develop evidence-based guidelines for individualized treatment of ITP patients, we asked 20 Population Intervention Comparison Outcome (PICO) format questions. These were addressed by 17 evidence evaluators using a literature pool of 288 articles identified by a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations. These were integrated by treatment domain chairs and then refined by iterative Delphi survey review to reach consensus on the final guidelines. In addition, 19 non-PICO questions covering scenarios in which evidence was lacking or of low quality were answered by expert opinion using iterative Delphi surveys with panelist integration and refinement. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The rigorous consensus process identified few comparative treatment studies, highlighting many areas of ITP treatment requiring additional studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Diagnosis of Immune Thrombocytopenia in Dogs and Cats.

ACVIM consensus statement on the diagnosis of immune thrombocytopenia in dogs and cats.

Immune thrombocytopenia (ITP) is the most common acquired primary hemostatic disorder in dogs. Immune thrombocytopenia less commonly affects cats but is an important cause of mortality and treatment-associated morbidity in both species. Immune thrombocytopenia remains a diagnosis of exclusion for which diagnostic guidelines are lacking. Primary, or non-associative, ITP refers to autoimmune platelet destruction. Secondary, or associative, ITP arises in response to an underlying disease trigger. However, evidence for which comorbidities serve as ITP triggers has not been systematically evaluated. To identify key diagnostic steps for ITP and important comorbidities associated with secondary ITP, we developed 12 Population Evaluation/Exposure Comparison Outcome (PECO) format questions. These questions were addressed by evidence evaluators utilizing a literature pool of 287 articles identified by the panelists using a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations that then were integrated by diagnosis and comorbidity domain chairs. The revised PECO responses underwent a Delphi survey process to reach consensus on final guidelines. A combination of panel expertise and PECO responses were employed to develop algorithms for diagnosis of ITP in dogs and cats, which also underwent 4 iterations of Delphi review. Comorbidity evidence evaluators employed an integrated measure of evidence (IME) tool to determine evidence quality for each comorbidity; IME values combined with evidence summaries for each comorbidity were integrated to develop ITP screening recommendations, which also were subjected to Delphi review. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The final consensus statement provides clinical guidelines for the diagnosis of, and underlying disease screening for, ITP in dogs and cats. The systematic consensus process identified numerous knowledge gaps that should guide future studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Treatment of Immune Thrombocytopenia.

A clinical guideline for the Iranian women and newborns in the postpartum period.

The postpartum is a vital period for women, newborns, spouses, parents, caregivers, and families. Regarding the importance of postpartum care and the lack of comprehensive and up-to-date clinical guidelines in the country of Iran, the postpartum clinical guidelines have been adapted. Cultural adaptation was conducted in three stages. In the first stage, the adaptation team was formed and the process was approved. During the second stage, a systematic literature review was conducted using international databases to identify English-language clinical guidelines published within the last 10 years. Out of 17 guidelines and documents initially selected, 5 guidelines meeting the inclusion and exclusion criteria and published within the last 5 years were chosen following a thorough review by the search team. In the secondary selection, the guidelines were investigated by two subject-matter experts based on AGREE II Checklist, and regarding the high evaluation score obtained by the WHO Recommendations on Postnatal Care of the Mother and Newborn (2022), and the National Institute for Health and Care Excellence (NICE,2021) guideline for postnatal care were selected for cultural adaptation. In the third stage, the opinions of experts from all over the country were collected and scored using the Delphi method, and a final guideline was formulated. The adapted postpartum clinical guideline has offered 56 recommendations. The recommendations are categorized into four major themes including mother care, newborn care, health system and health promotion interventions and post caesarean care. Applying evidence-based recommendations for the care of mothers and babies in the postpartum period will enhance the health system, promote the provision of care after vaginal and caesarean births, and ensure a positive postnatal experience for mothers, fathers, babies, and families.

Collaborative design of a Chinese herbal medicine case report guideline (CHM-CARE)

IntroductionCase reports have a long history in Chinese herbal medicine (CHM), and even into the modern day, case reports are still a preferred format for traditional East Asian medicine (TEAM) practitioners. However, the tradition of case reports in teaching and research is not nearly as common in the English-speaking world as in China, possibly due to the lack of a specific case report guideline. This study aimed to co-design a CHM guideline (CHM-CARE) to assist practitioners in compiling structured and comprehensive case reports. MethodsA two-phased mixed approach was used to develop the case report guideline. In phase one, focus groups of TEAM practitioners were used to determine what components of existing guidelines (e.g., Case Report (CARE) and Case Report in Chinese Medicine (CARC)) were relevant to include, along with any additions or changes. Content analysis of phase 1 provided the checklist items for a two-round Delphi process (Phase 2). All checklist items from the first Delphi round with a median of three or higher were included in the second round, with consensus set at >70 % for inclusion in the final guideline. ResultsA total of 18 CHM practitioners from four countries joined five separate focus group discussions. Focus group discussions led to 98 checklist items being used in the first round of the Delphi process. Fifteen international experts on case reports participated in two rounds of Delphi. A total of 69 checklist items moved forward into the second round where 61 items (88 %) reached consensus and formed the final CHM-CARE guideline. ConclusionKey elements of a herbal medicine case report checklist were identified, and a 61-item case report guideline (CHM-CARE) was produced, providing clear guidelines for case reports to TEAM practitioners operating in private practice.

Development of mental health first-aid guidelines for a person after a potentially traumatic event: A Delphi expert consensus study in Argentina and Chile

BackgroundExposure to potentially traumatic events increases the risk of a person developing a mental disorder. Training community members to offer support to a person during and after a traumatic situation may help lower this risk. This study reports on the cultural adaptation of Australian mental health first aid guidelines for individuals exposed to a potentially traumatic event to the Chilean and Argentinian context.MethodsA Delphi expert consensus study was conducted with two panels of experts, one of people with lived experience of trauma (either their own or as a carer; n = 26) and another one of health professionals (n = 41). A total of 158 items, drawn from guidelines developed by Australian experts in 2019, were translated to Spanish and evaluated in a two-round survey process. The panellists were asked to rate each item on a five-point Likert scale; statements were included in the final guidelines if 80% of both panels endorsed the item as “essential” or “important”.ResultsConsensus was achieved on 142 statements over two survey rounds. A total of 102 statements were included from the English-language guidelines, and 40 locally generated statements were accepted in the second round. Local experts endorsed a larger number of items compared to their counterparts in Australia and emphasised the importance of acknowledging the first aider’s limitations, both personally and as part of their helping role. Additional items about working as a team with other first responders and considering helping the person’s significant others were endorsed by the local panellists.ConclusionsThe study showed a high level of acceptance of the original actions suggested for inclusion in the guidelines for Australia, but also a significant number of new statements that highlight the importance of the adaptation process. Further research on the dissemination of these guidelines into a Mental Health First Aid training course for Chile and Argentina is still required.

An Approach to Diversifying the Selection of a Guideline Panel-The Process Utilized for the Updated Adult Critical Care Ultrasound Guidelines.

Clinical practice guidelines are essential for promoting evidence-based healthcare. While diversification of panel members can reduce disparities in care, processes for panel selection lack transparency. We aim to share our approach in forming a diverse expert panel for the updated Adult Critical Care Ultrasound Guidelines. This process evaluation aims to understand whether the implementation of a transparent and intentional approach to guideline panel selection would result in the creation of a diverse expert guideline panel. This study was conducted in the setting of creating a guideline panel for the updated Adult Critical Care Ultrasound Guidelines. Understanding that family/patient advocacy in guideline creations can promote the impact of a clinical practice guideline, patient representation on the expert panel was prioritized. Interventions included creation of a clear definition of expertise, an open invitation to the Society of Critical Care Medicine membership to apply for the panel, additional panel nomination by guideline leadership, voluntary disclosure of pre-identified diversity criteria by potential candidates, and independent review of applications including diversity criteria. This resulted in an overall score per candidate per reviewer and an open forum for discussion and final consensus. The variables of diversity were collected and analyzed after panel selection. These were compared with historical data on panel composition. The final guideline panel comprised of 33 panelists from six countries: 45% women and 79% historically excluded people and groups. The panel has representation from nonphysician professionals and patients advocates. Of the healthcare professionals, there is representation from early, mid, and late career stages. Our intentional and transparent approach resulted in a panel with improved gender parity and robust diversity along ethnic, racial, and professional lines. We hope it can serve as a starting point as we strive to become a more inclusive and diverse discipline that creates globally representative guidelines.

Development of Design Principles of Group Awareness Tool for Facilitating Computer-supported Collaborative Argumentation

As one of the forms of collaborative learning, collaborative argumentation can improve students’ argumentation skills, promote effective content learning and cultivate critical thinking. Especially in the field of Computer-supported Collaborative Learning (CSCL), such as conflicts between group members, free-riding behavior, and unequal participation occur frequently. At the same time, in the CSCL environment, it is difficult to coordinate one’s actions with other group members’ actions. These problems are mainly caused by learners who cannot obtain group awareness information about accompanying learners and the current group. Therefore, this study according to the previous research, the initial design principles and initial specific guidelines for the group awareness tool were identified. After that, three educational technology experts reviewed the initial design principles and guidelines. The modified specific guidelines were applied to the two-week classroom teaching of 45 first-year students in a class. In addition, a learners’ response survey was conducted on the students who actually participated in the computer-supported collaborative argumentation activities. Finally, the results of questionnaire surveys (n=45) and interviews (n=5) were analyzed, and the final specific guidelines were developed. According to the research results, collaborative argumentation based on group awareness tool solves the problem that general collaborative argumentation activities can’t obtain timely information on the cognitive, behavioral, and social awareness of accompanying learners and the current group study situation. It can continuously maintain their study motivation and promote interaction among learners to improve the quality of computer-supported collaborative learning.

The diagnosis and management of systemic autoimmune rheumatic disease-related interstitial lung disease: British Society for Rheumatology guideline scope.

Interstitial lung disease (ILD) is a significant complication of many systemic autoimmune rheumatic diseases (SARDs), although the clinical presentation, severity and outlook may vary widely between individuals. Despite the prevalence, there are no specific guidelines addressing the issue of screening, diagnosis and management of ILD across this diverse group. Guidelines from the ACR and EULAR are expected, but there is a need for UK-specific guidelines that consider the framework of the UK National Health Service, local licensing and funding strategies. This article outlines the intended scope for the British Society for Rheumatology guideline on the diagnosis and management of SARD-ILD developed by the guideline working group. It specifically identifies the SARDs for consideration, alongside the overarching principles for which systematic review will be conducted. Expert consensus will be produced based on the most up-to-date available evidence for inclusion within the final guideline. Key issues to be addressed include recommendations for screening of ILD, identifying the methodology and frequency of monitoring and pharmacological and non-pharmacological management. The guideline will be developed according to methods and processes outlined in Creating Clinical Guidelines: British Society for Rheumatology Protocol version 5.1.

Simultaneous treatment of anterior urethral stricture and benign prostatic hyperplasia: primary experience overview

Introduction. Research on the treatment of patients with a combination of anterior urethral stricture and benign prostatic hyperplasia (BPH) is basically absent in the worldwide literature.Objective. To analyse the primary experience results with simultaneous treatment of anterior urethral stricture and BPH.Materials & methods. The study included four patients with anterior urethral stricture and BPH, who underwent simultaneous surgical treatment including perineal / penile urethrostomy and thulium laser enucleation of the prostate. The success criterion for treatment was considered to be the absence of obstructive lower urinary tract symptoms requiring the use of endoscopic or open surgery, regardless of whether urethrostomy was considered as the first step or the final option for urinary diversion.Results. The age of the patients ranged from 54 to 69 years (mean 63.0 ± 6.5 years). In one (25%) patient the stricture was localised in the penile urethra and in three (75%) patients it was localised in the bulbous urethra. The stricture length ranged from 1.0 to 3.0 cm (mean 2.1 ± 0.9 cm). The prostate volume varied from 45 to 77 cc (mean 63.8 ± 13.5 cc). One patient had cystostomy drainage. The post-void residual volume among 3 patients with preserved urination ranged from 90 to 130 ml (mean 113.3 ± 20.8 ml). Postoperative follow-up periods ranged from 3 to 18 months (mean 11.3 ± 7.4 months). At these follow-up periods, treatment was successful in all four (100%) patients. No intra- or postoperative complications were observed.Conclusions. The proposed method can be successfully applied in patients with a combination of anterior urethral stricture and BPH. However, the final guidelines for the management of such patients can be developed after further research.

Nasal high flow therapy in remote hospitals: guideline development using a modified Delphi technique.

In remote Australian hospitals there are no onsite paediatric intensive care units (PICUs), increasing the reliance on aeromedical retrieval to access tertiary care. Nasal high flow (NHF) therapy is an oxygen therapy used in tertiary hospitals to treat paediatric patients with respiratory conditions. In rural and remote Queensland, Australia, the use of NHF therapy is inconsistent and there are no guidelines on how this therapy should be implemented in practice. Therefore, three remote hospitals within the Torres Strait and Cape York commenced a project to improve consistent and equitable access to NHF therapy. Implementing NHF therapy in remote hospitals may improve health and social outcomes for children with acute respiratory distress. A clinical guideline for the use of NHF therapy in the three participating remote hospitals was published on 28 October 2021. This study aimed to develop a clinical guideline for the use of NHF therapy in three remote hospitals. A modified Delphi technique was used to develop the guideline. Remote medicine and nursing clinicians at the three study sites, retrieval experts, a receiving tertiary-based paediatrician, PICU specialists and NHF therapy experts made up the expert panel of participants. These experts participated in an iterative round table discussion to develop remote-specific guidelines for the use of NHF therapy. Prior to the meeting, panellists were provided with an executive summary of the current literature on NHF therapy implementation with key questions for consideration. Participants were able to add relevant issues ad hoc. A final guideline representing the panellists' recommendations was submitted to the Torres and Cape Health Service for ratification. Remote-specific decisions on the following topics were produced: environment of care, nasogastric tube usage, timings of chest X-ray, automatic approvals to arrange courier services for pathology, medication use, staff training; staff ratios, observations regimes, both tertiary and local medical consultation frequency and the experience level of the medical officer required to attend to these consultations, location of the on-call medical officer, documentation, escalation of care considerations and disposition of the patient in relation to retrievals. Decisions were made to mitigate two highly representative remote factors: delays in the workplace practices, such as time to arrange treatment locally and delays in retrievals; and burden of the lack of access to services, such as lack of access to trained staff, staffing levels on-shift, adequate oxygen and equipment/consumable supplies. The aim was to develop a clinical guideline that was contextualised to the remote hospital. This outcome was achieved by using a modified Delphi technique, with a panel of experts providing the decision-making for the guideline. Consistency and safety were addressed by reducing delays in workplace practices; examples were time to arrange treatment locally and mitigate delays in an unknown time to retrievals, access to trained staff, staffing levels, and communication between remote and tertiary teams.

ATM 사용자 리서치를 통한 사용성 개선을 위한 연구

With the development of information and communication technology, the use of smart banking, a non-face-to-face financial business processing system, is expanding. However, the elderly who have difficulty using smart devices or users who have anxiety about using online banking visit the bank in person, make deposits and withdrawals through employees, or solve banking business by using ATMs. In this way, it aims to present interface guidelines for useful ATMs that can appropriately use cash and electronic payment methods according to the situation. This study conducted usability tests, SUS evaluations, and interviews to analyze the usability of existing ATMs, and produced a prototype by improving the interface through the usability analysis results of existing ATMs and expert advice. Significance tests were conducted through a prototype with an improved interface, and final guidelines were presented through this. The ATM interface guidelines derived through this study are expected to help minimize confusion experienced by various users when using ATMs.